Impact of a Clinical Decision Support System on the Management of Patients with Hypercholesterolemia in the Primary Healthcare Setting

Introduction and objectivesThe Optimcare study objective was to assess the impact on effectiveness and costs of a practice guideline implemented through a clinical decision support system (CDSS) for the management of patients with hypercholesterolemia in the primary healthcare setting.Study design and perspectiveThe study design was a prospective, naturalistic, single-center (Vila Olímpica Primary Health Care Center, Barcelona, Spain), before-and-after design. Two periods were compared: (i) one year before (PRE) the implementation of the CDSS; and (ii) 1 year after (POS) the implementation of the CDSS. The recruitment period started in October 1999 (first patient, first visit) and ended 1 year later (last patient, last visit). The effectiveness was defined by the achievement of the treatment goals in PRE and POS periods. Costs of treatments, visits, and laboratory assessments were estimated from the social perspective (year of costing 2002).MethodsThe CDSS implemented algorithms agreed by the participating physicians based on national clinical guidelines, with therapeutic recommendations directed to achieve low-density lipoprotein (LDL) objectives in a cost-effective manner.PatientsA total of 500 patients with hypercholesterolemia were randomly selected from the Primary Health Care center database.Main outcome measures and resultsAfter implementing the CDSS, the proportion of patients meeting the treatment goals increased by 11.9% (95% CI 5.9, 17.8), the median LDL values decreased by 10 mg/dL (95% CI −14, −6), the proportion of patients treated with drugs decreased by 14.6% (95% CI −19.4, −9.7), and the mean total costs per patient decreased by €78.4 (95% CI −94.7, −62.1). Therapeutic decisions agreed with the CDSS recommendations in 87.4% of the POS visits.Discussion and conclusionsDespite some limitations in the design, the results of the present study strongly suggest that it is possible to optimize the efficiency of the management of hypercholesterolemia in standard practice by the implementation of a CDSS. After this implementation, not only were the effectiveness outcomes improved, but also a yearly mean reduction of €78.4 in the costs of management of patients with hypercholesterolemia was observed. This cost reduction, which was mainly due to a decrease in the number of patients treated with drugs, reverted to the spontaneous trend of a marked increase in the use of statins that was reported in Spain and other European countries during the study period.